I had the opportunity yesterday to present findings from the PCHIT Initiative to the Institute of Medicine (IOM) Roundtable on Health Literacy (slides will be available to the public there soon). Yesterday’s forum was titled a “Workshop on Health Literacy, eHealth & Communication: Putting the Patient First.” Although I have been reflecting quite a bit on PCHIT findings over the last month, this was an opportunity to focus in more specifically on health literacy issues.

There’s no doubt that PCHIT has demonstrated that great opportunities exist for improving health literacy by implementing PCHIT applications. That can be done in two ways–either by using PCHIT applications for skill-building or by deploying new technologies that allow for effective communication without improving “health literacy”–at least defined in its traditional way (ability to understand written health information).

In order to do either of these, we do need to ensure that PCHIT implementation addresses two strategic and operational issues. First, more effort needs to be invested in connecting personal health information (PHI–an individual’s clinical data) to health content that can contextualize data points for the individual. Second, those organizations that implement PCHIT need to develop a concerted strategy for driving adoption of those tools by working with the clinicians to gain comfort in using the tools with their patients.

The biggest health literacy challenges that I saw in shadowing clinicians and patients were not related to race, ethnicity or education, but cognitive function. Particularly for patients with severe mental illness or developmental disabilities, PCHIT applications need to engage effectively with some ancillary caregiver, and those community hand-offs often were not smoothly handled. Language barriers sometimes were a health literacy challenge as well–though not for as much for Spanish (the encounters I observed with Spanish-speaking patients in safety-net and commercial settings were conducted in Spanish though they did not always have Spanish health content available to prescribe as follow-up) as for other languages.

Some of my comments also mirrored insights of others. For example, Ruth Parker from Emory University described health literacy as the ultimate patient-centered care. That is, there’s nothing that more addresses the on-the-ground, day-to-day needs of individuals than whether they can really understand the health information that they need to live healthy lives. Dawn Gauthier talked about Peace Health’s approach to PHR development that started with the premise that, “patient-centered care = user-centered design” and then proceeded to talk to patients, observe them, and listen to them tell their stories. Also, the importance of tailoring content came up–recognizing that health literacy, behavior change, and other critical health issues require a personalized approach to health information and health care. Finally, Cynthia Solomon from MiVia explained how PCHIT tools can serve as a “bridge” between disparate parts of the delivery system, much as the IxCenter has described the role of Ix as offering the consumer a bridge between encounters with different providers.

Chuck Friedman, Deputy Director of the Office of the National Coordinator for HIT also gave a glimpse into ONC’s soon-to-be-released strategic plan. It will center around “person-focused health care and improved population health enabled by IT.” That sounds a lot like “patient-centered HIT” to me.

This entry was posted on Tuesday, March 18th, 2008 at 10:33 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.